Provider Demographics
NPI:1316104383
Name:YOUNG, MICHELE D (CST-FA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CST-FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 OAKWATER CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6200
Mailing Address - Country:US
Mailing Address - Phone:407-650-0000
Mailing Address - Fax:407-650-8757
Practice Address - Street 1:3802 OAKWATER CIR STE 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6200
Practice Address - Country:US
Practice Address - Phone:407-650-0000
Practice Address - Fax:407-650-8757
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL107619363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical